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Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review

Mold, Freda Elizabeth, Hendy, Jane, Lai, Yi-Ling and de Lusignan, Simon (2019) Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review JMIR Medical Informatics, 7 (4), e13042.

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Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain.


This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care.


A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis.


This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes.


E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Health Sciences
Authors :
Mold, Freda
Hendy, Jane
Lai, Yi-Ling
de Lusignan,
Date : 3 December 2019
DOI : 10.2196/13042
Copyright Disclaimer : ©Freda Mold, Jane Hendy, Yi-Ling Lai, Simon de Lusignan. Originally published in JMIR Medical Informatics (, 03.12.2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Informatics, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
Uncontrolled Keywords : Referral and consultation; Health services accessibility; Primary health care; General practice; Patient access to records; Patient portals; Web-based access
Depositing User : Diane Maxfield
Date Deposited : 13 Jan 2020 11:10
Last Modified : 13 Jan 2020 11:10

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